Telemedicine network as a disaster risk reduction Prof. Shinichi Egawa, M.D., Ph.D., F.A.C.S Div. International Cooperation for Disaster Medicine IRIDeS, Tohoku University
Lessons from 1923 Great Kanto Earthquake September 1, 1923 11:58:32 M7.9 Cause of Death Asphyxia 11% Unknown 2% Drowning 1% Fire 86% The buildings should be fire-resistant Every Sept. 1 is the Disaster Drill Day
Lessons from 1995 Great Hanshin Awaji Earthquake January 17, 1995 05:46 M7.3 Cause of Death Unknown 4% Fire 13% Asphyxia 83% The buildings should be quake-proof Japanese Association for Disaster Medicine was established
Lessons from Great Hanshin Awaji Earthquake in Medial Management in Japan No disaster specific hospital Establishment of Disaster Base Hospitals Lack of medical care within 72 h Establishment of DMAT No wide area transportation Establishment of Staging Care Unit (SCU) and Wide Transportation Network No disaster medical information system Establishment of Emergency Medical Information System (EMIS) No disaster medical coordinator Establishment of Disaster Medical Coordinator
Lessons from 2011 Great East Japan Earthquake 11, 2011, 14:46 M9.0 Fire 1% Asphyxia 4% Unknown 2% Drowning 93% 2011 White pages, Japan Gov.
Hydrogen explosion of Unit 3 10:01 March 14, 2011 Dr. Akashi S, National Institute of Radiation Science NTV (Nihon Television) The explosion of Unit 3 of the Fukushima Dai-ichi NPP 6
Number of patients within a week 1200 1000 800 600 Black Red Yellow Green 1200 1000 800 600 Black Red Yellow Green 400 200 400 200 0 11 12 13 14 15 16 Tohoku Univ. Hp. 17 18 0 11 12 13 14 15 16 17 Ishinomaki Red Cross Hp. 18 1199 beds Drs. >1,000 Ns. >2,000 Population 1,5M Age >65 21% 452 beds Drs. 50 Ns. 300 Population 0.25M Age >65 25% 50 km (30 miles)
Ogatsu Hospital Three story was inundated. 40/40 Pts, 66/70 Medical Staff were killed Hospital Evacuation Futaba Hospital Forced to evacuate Misinformation created unattended patients 45/440 Pts died during Tx Nucl. PP Ishinomaki Municipal Hospital 120 Pts, 250 Medical Staff were isolated Rikuzen Takada Hospital Four story was inundated 12/51 Pts, 8/82 Medical Staff were killed 170 Isolated people Shizugawa Hospital 67/109 Pts, 4 Medical Staff were killed 7/150 Isolated people died of hypothermia
Residential and hospital evacuation from restricted area Fukushima Univ. Hp (Nucl. Med) SCU Futaba Hospital was forced to evacuate. Misinformation created unattended patients 45/440 Patients died during transportation due to lack of nutrition, heat and care Decontamination Center
SCU worked as a triage center Hanamaki SCU DMAT who reached by Air, had to stay in SCU. SCU was full of staff enough to accept direct transportation from affected hospitals. SCU as a human resource center to provide assistance to local hospitals
Flood-in of supporting medical teams and lack of coordination University Hospital Alliance Foreign Medical Team Tohoku University Hospital AMDA Medical Societies Japan Medical Associati on TMAT DMAT Japan Red Cross PCAT Sendai Medical Center Ishinomaki Red Cross Hospital
Telemedicine in disaster Needs Distance from the stricken area to the headquarter and helpers Confusion in supporting and help-receiving Medical and public health needs assessment Relief coordination CBRNE combined disaster Problems Robust capacity and durability in harsh conditions Easy operability for every one Actual treatment needs human on site and human network Information sharing and geographical mapping with other sectors Daily use
Hazards NATURAL SOCIETAL TECHNOLOGICAL BIOLOGICAL Typhoon Earthquake Flood Landslide Volcanic Activity Tornado Tsunami El Niño Snow storm Explosion Mass Gathering Armed Conflict Stampede Ambush Hostage taking War Terrorist Attack Fire Transportation Accident (Land, Sea, Air) Chemical Spill /Leak Infrastructure Accidents Food Poisoning Disease Outbreak Increasing cases of disease Red Tide Know your risk Reduce your risk Prepared to act Risk = Hazard x Vulnerability Capacities Capacities Telemedicine Network
The 3 rd World Conference on Disaster Risk Reduction Know your risk Reduce your risk Prepared to act Increase the visibility of health professionals
Needs Change the concept of Risk Reduction Top 3 priorities for communities (UN Survey) 1. A good education 2. Better healthcare 3. An honest and responsive government Change of Risk Paradigm Shift Climate Change Rapid urbanization Poverty Lack of resource Loss of biodiversity Resilient Community Safe Hospital Safe School Mental and Physical Better access Quality of Life Effective Response Death Injury Illness Disability Lessons from past disaster Hazard-proof Structure Early Warning Communication Funding and Development
Human Security in Disaster Clusters Telemedicine Network Communication Health Care Protection Food Security Better access (Accessibility) Education Safe School Mental and Physical Health WASH Shelter (Housing) Safe Hospital Logistics Early Warning Hazard-proof Structure Effective Response Funding Early Recovery Health-centered approach is important